Background: PEPFAR funding changes have resulted in HIV clinic closures, necessitating the transfer of large cohorts of patients to government-funded, community-based clinics. We evaluated linkage to care following a rapid, large-scale transfer of patients from a hospital-based HIV clinic in South Africa. Methodology: All adult (≥18y) patients on ART who visited the hospital-based HIV clinic in Durban from March to June 2012 were transferred to >170 clinics. Hospital counselors identified patients’ target transfer clinic based on their home location and care needs. Study staff surveyed subjects 5-10 months after transfer to assess self-reported linkage to the target clinic. To examine the validity of self-report, we randomly selected 8 clinics from the 80 clinics closest to the hospital for record reviews. We estimated the overall success of transfer as a weighted average of linkage to care for subjects reached and not reached for the survey, adjusted for results of the validation visits. Results: Of the 4,690 patients who visited the HIV clinic in the year prior to its closure, 3,927 (84%) were transferred and phoned at least once. Mean age was 40 years (sd 9.3), 59% were female, and most recent CD4 prior to transfer was 375/μl (IQR 251-530). Of transferred patients, 3,384 (86%) were reached and completed the survey; 3,376 (99.8%) reported attending a transfer clinic. Of those reached, 866 (26%) reported visiting a different clinic than that assigned. The most common reasons for attending alternative clinics were: told by the receiving clinic to go elsewhere (23%), stigma concerns (16%), and inconvenient location (14%). Among the 756 patients assigned to the 8 validation clinics, 659 (87%) were reached for the survey. 531 (81%) of those surveyed reported going to their assigned clinic. Among those who self-reported attending their assigned clinic, 446 (84%) had a visit validated in the clinic record. Of the 46 people who self-reported attending a validation clinic to which they were not originally assigned, 39 (85%) had a validated visit. Of the 97 patients who could not be reached for the survey, 59 (61%) had a validated visit at their assigned clinic. Based on the validation rates for reached, self-reported, and unreached patients, the estimated success of transfer for the cohort overall was 81%. Conclusions: A large majority of patients reported successful transfer from a hospital- to a community-based clinic in South Africa, though a quarter of patients attended a different clinic than assigned. Validation of self-reported attendance at a clinic highlights that nearly 20% of patients may not have linked to care. Efforts to optimize transfers to community sites require accurate contact details and collaboration with receiving clinics to ensure successful linkage to care.
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